Can cervical VEMPs predict recurrence in benign paroxysmal positional vertigo?

Benign paroxysmal positional vertigo (BPPV) is the most frequent form of peripheral vertigo, characterized by a high tendency to relapse. To date, few studies have been published on the possibility that disorders of the maculae can act as a possible predisponing factor for recurrences. We collected cervical vestibular evoked myogenic potentials (C-VEMPS) in 3043 subjects treated for BPPV in two centers between 2014 and 2018. They did not report lifetime vertigo outside BPPV. The mean age in the total population was 63.4±13.3 years. There were 2339 (76.9%) females. In the total sample 763 had pathological VEMPs (25.1%). Recurrent episodes were demonstrated in 2049 subjects (67.3%). In our cohort, patients presenting pathological VEMPs more frequently had bilateral recurrences (72.7%) than patients with normal VEMPs. A Pearson test demonstrated a correlation between bilateral pathological VEMPs and presence of bilateral recurrences (p≤0.001). In contrast, no correlation was found between pathological VEMPs and the age of patients (p=0.2). Our data suggest the hypothesis that bilateral otolithic macular alterations should be considered among the causes of recurrences.